Unhappy campers: easing your little one's discomfort

January 31, 2017

Everyone wants their child to be a happy little camper, here's how to help your baby with potential problems that cause them discomfort.

Colic and reflux

What is colic?

Colic is defined as inexplicable bouts of crying, lasting for more than three hours a day and occurring more than three days a week in an otherwise healthy child. It usually happens between the ages of two weeks and four months. To a new mum, it can mean struggling to soothe an upset baby day after day without really knowing what’s wrong. Although there’s no definitive answer, many baby care experts believe that there are solutions rather than it just being something to be endured.

Dr Howard Chilton is a neonatal paediatrician in Australia who has written extensively about newborn care and colic in particular. He says colic is not a digestive problem in babies, as is sometimes suggested, but rather that, “As they move towards six weeks, they become more visually aware and can become over-stimulated. Often, if they’re crying inconsolably they get handled a lot. The more they’re handled, the more excited they get and the more stimulated. It’s a vicious cycle.”

Dr Chilton recommends trying to replicate womb-like conditions for babies during this time to help soothe them. For an upset baby, he recommends reducing stimulation by deterring visitors, taking baby into a dimly lit room, feeding him on demand and then swaddling and holding him close to your chest so he can hear your heartbeat, and patting him gently until he is soothed before putting him down to sleep once he’s drowsy. Even then you may need to stay with him, gently patting his bottom at the speed of your heart rate before he nods off completely.

He warns it’s not a quick-fix solution – it may take several hours for baby to settle the first time – and the routine may need to be used daily for up to three months until baby has learned to self-soothe (see babydoc.com.au for more info).

Baby whisperer Sharlene Poole also believes that colic, and in some cases reflux, can be avoidable and says she has come to view these symptoms as “babies trying to tell us that something we are doing to care for them is not quite right for them personally.”

What is reflux?

“Reflux happens after a feed,” explains Sharlene Poole, “when the milk comes back up through the baby’s oesophagus, sometimes bringing acid from the stomach, which causes the baby pain. Babies with reflux suffer after every feed and struggle to lie flat despite being well-winded. They struggle to settle to sleep on their back, and often need to be held.”

Sharlene says some babies will spill, making the problem easier to see, while others have what is known as ‘silent reflux’, where the feed comes up the oesophagus, but not out. These babies are harder to diagnose because they don’t show such obvious signs.

“While I believe many babies do need help for reflux through medication, I also believe that mild reflux can be exacerbated if some of the points on my checklist (see below) are not being addressed,” says Sharlene.

“For example, a baby who is not sleeping well due to being overtired, not feeding well or not getting all of his wind up will also not tolerate the discomfort they might get from mild reflux. They’re just like adults – when we are tired we are less tolerant and more likely to react to situations that we would normally handle quite well!”

Sharlene says the good news is that all babies grow out of the severity or frequency of their unsettledness, but parents and caregivers can help them too as it’s not normal or necessary for babies to have to cope daily with discomfort or pain. “Seek help as soon as you know you have a problem,” advises Sharlene. “Talk to your doctor and get a second opinion if you don’t get solutions that you are happy with. The changes can take a few days to a few weeks to implement so it’s worth getting onto it as soon as you can.”

Sharlene recommends considering the following:

Does baby sleep a lot in the morning but is very wakeful in the afternoon and evening?

“You may need to increase baby’s awake time as the day goes on, so they’re tired enough to balance sleep over the day and not get over-tired from imbalance i.e. not cope with normal windy issues at end of the day.”

Does the mother have a fast flow of milk, resulting in the baby gulping a lot during each feed?

"Baby may be taking in air, so stop and wind them throughout and after each feed."

How long is the baby awake for each feeding and sleeping cycle, and how long do they take to settle to sleep?

“If a baby takes a long time to settle to sleep it can mean he’s not tired enough when he’s being put to bed.

Sometimes people keep babies up far too long and they are overtired, but most parents put their babies to bed at the same time for too long, when they should be gently increasing their awake time as the baby goes through developmental changes. We might presume they’re in pain or unsettled due to reflux or wind when in fact they’re protesting due to not being quite ready for bed! Or they may be accustomed to short sleep cycles because they weren’t tired enough to sleep through and in turn they can’t cope as well with mild wind/reflux.”

Is there a family history of allergies/intolerances?

“It may pay to get this checked with your family doctor.”

Can they lay baby on her back to play and is she happy to do so?

“If baby can play lying flat on her back and sleeps well on her back then any reflux is mild and the right winding and routine will help her to be more settled. Babies with bad reflux will not like lying flat for long periods.”

Nappy rash

A common problem that can cause misery for very little ones is nappy rash, which is quite simply a red rash that appears in the nappy area. The skin looks red and raw and can be spotty. It may be sore for baby to have their bottom wiped and they may be unsettled or irritable because of it.

Nappy rash can flare up very quickly, last a couple of days and then subside. It’s usually caused by wet skin, but teething, a change in diet, diarrhoea or sickness are also considered factors.

Although not serious, nappy rash isn’t much fun and there are some simple and effective ways to treat it.

Always change a soiled nappy as soon as possible

A disposable nappy can take a number of wees before it needs changing, but it shouldn’t become so full that the inside of the nappy (the part that touches the baby’s bottom) is damp or wet. The best plan is to change baby’s nappy regularly, wipe their bottom with a damp cloth or baby wipe after each change and apply a barrier cream to protect the skin.

Give baby some 'no-nappy' time each day.

In fine, warm weather you can do it outside, or if you’re indoors you might want to pop a towel underneath them in case of accidents.

For persistent nappy rash that doesn’t respond to barrier creams, a prescribed medicated cream such as an antifungal or hydrocortisone may be necessary. If the nappy rash doesn’t improve in a few days or gets worse, talk to your nurse, doctor or health professional. It may mean there is a skin infection present, such as thrush.

Eczema

Penny Jorgensen of Allergy New Zealand explains childhood eczema and how to manage it.

Eczema, otherwise known as atopic dermatitis, is a chronic skin condition affecting up to 30 per cent of children. In most cases it is mild and the majority of children will outgrow it.

For those with moderate to severe eczema, however, there can be a significant impact on quality of life for children and their families.

It’s unclear what causes eczema to occur in some children and not in others but, as with other atopic conditions, it is believed to be due to genetic and environmental factors combining to cause dysfunction in the skin barrier and immune system. The result is dry itchy skin that is easily inflamed.

Eczema often starts in children between three and six months old with itchy red patches on the face and then on the body. Because the skin’s ability to act as a barrier is impaired, it can be easily inflamed by things that irritate the skin, such as soaps, detergents, fragrances, chemicals, rough textures in fabrics and so on. Inflammation increases the itch. The condition also makes it hard for the skin to maintain the body’s normal temperature.

Children with eczema often feel hotter than the rest of us, and heat can make them itch more.

Itchy skin is incredibly distracting and all the child will want to do is scratch it. However, scratching can break the skin causing an immune response that increases the itch and inflammation; and also increases the risk of infection.

It is vital to understand the key steps to managing eczema, and for parents/caregivers to have comprehensive education and support from health professionals.

Apply an emollient several times a day all over the body to keep the skin well-moisturised.

This helps the skin maintain its barrier function and reduces the potential for inflammation. Emollients should be detergent and fragrance-free, and used liberally. They can be prescribed by a GP.

Topical steriods shuold be used if the skin it itchy and inflamed (known as active eczema).

They’re very effective if used appropriately and have few side-effects (most active eczema will not settle without the use of topical steroids.)

Daily baths in warm water using emollients to replace soap or detergents help the skin absorb the moisturiser.

Alternatively, use wash-off emollients in the shower. Pat the skin dry afterwards – don’t rub. Be careful as the bath and the child will be very slippery!

If the skin becomes infected, the child will need oral antibiotics as well as continuation of emollients, topical steroids and baths.

For severe eczema and skin infections not responding to treatment, referral should be made to a paediatric specialist.

More information about eczema is available from Allergy New Zealand at allergy.org.nz as well as on kidshealth.org.nz/eczema. Both websites have a series of video clips on the steps for managing eczema.